Why the ‘Most Trusted’ Professionals’ Union in the Nation Endorsed Bernie Sanders

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National Nurses United has chosen Sen. Bernie Sanders (I-VT) as its preferred candidate for president, dealing a blow to other candidates who had sought the union’s endorsement — namely, Hillary Clinton.

NNU announced its decision on Monday at an event in Oakland, California. The group, which represents approximately 185,000 nurses and is the largest of its kind in the country, said Sanders’ policies “align with nurses from top to bottom.” Specifically, the group cited his support for the Affordable Care Act and Medicare, and his desire to fight climate change.

The endorsement is Sanders’ first from a national union, and while it’s not expected to bring in large amounts of cash to his campaign, it is at least somewhat important. NNU has thousands of members in early primary states like New Hampshire and Iowa, and Sanders’ two biggest Democratic rivals — Clinton and Maryland Gov. Martin O’Malley — had also competed for the endorsement. Nurses are also consistently rated the “most trusted” professionals in the country, with the vast majority of Americans giving them high ratings of honesty and ethics.

But why did Sanders secure union members’ votes over Clinton or O’Malley? In the minutes following the announcement, Buzzfeed News reported that the Keystone XL pipeline was “the deciding factor,” noting Clinton’s now-infamous refusal to say whether she would approve the controversial project. Conversely, Sanders has staunchly opposed the pipeline for the same reasons NNU has, saying a spill would exacerbate health problems like asthma and nosebleeds.

However, NNU spokesperson Martha Wallner said the decision to choose Sanders ran deeper than Keystone XL. In a phone interview, Wallner said all three candidates had competed for the endorsement by filling out a seven-question survey about issues that aligned with NNU’s values — and only Sanders scored a 100 percent. O’Malley scored 86 percent, and Clinton scored just 43 percent, she said.

“We want it all,” Wallner said. “It goes far beyond just Keystone XL.”

ThinkProgress reviewed a copy of each candidates’ answers to the survey, and the resulting scorecard created by the NNU Executive Council. Clinton answered “no commitment” on four out of seven issues. One of those was, of course, in response to whether she would oppose the Keystone XL pipeline. But Clinton would also not commit to supporting “a publicly administered, single-payer, universal healthcare system,” nor would she commit to supporting legislation to impose a .5 percent tax on Wall Street speculation. She also would not commit to publicly opposing the Trans-Pacific Partnership, which nurses oppose because they say it allows pharmaceutical companies to block distribution of cheaper generic medications.

“She’s just been vague,” Wallner said. “Sanders has taken clear positions on the areas that we care about.”

O’Malley supported nearly all of NNU’s preferred policies, but would not commit to supporting a law that would require minimum, specific nurse-to-patient ratios at all times in all U.S. hospitals, a policy which nurses say would prevent chronic understaffing. O’Malley also added a caveat to his support for a single-payer healthcare system — he said he was for it, but would not specifically commit to federal legislation.

Clinton also added caveats to a number of union issues she said she would support. For example, she said she would “work to establish” minimum nurse-to-patient ratios, but would not fully commit to a federal policy. She also said she would support giving collective bargaining rights to employees in the Veterans Health Administration, but would not specifically commit to the VA Employee Fairness Act, which, among other things, gives collective bargaining rights to employees in the Veterans Health Administration.

In all, on the questionnaire, the three Democratic candidates only fully agreed on one thing — opposing right-to-work laws. Those laws allow union-represented workers to opt out of paying union fees, meaning they can benefit from collective bargaining without paying dues. Sanders, O’Malley, and Clinton all said they would veto a national right-to-work law should Congress pass one.

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